固定与旋转平台型假体置换治疗膝骨关节炎的比较
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摘要
[目的]比较固定平台假体(FB)与旋转平台假体(RP)应用于人工全膝关节置换术(TKA)治疗终末期膝骨关节炎的效果。[方法]2014年6月~2015年6月本院骨科收治的终末期膝骨关节炎患者86例,所有患者均行全膝关节置换术,根据受试者选择置换假体的意愿分为FB组(共40例)和RP组(共46例)。记录比较两组围手术期情况(包括手术时间、切口长度、术中失血量、术后引流量、下地时间等)及术后并发症发生情况,比较术前及末次随访时两组KSS评分、疼痛评分及髌骨评分,并摄膝关节X线片进行影像学评估。[结果]两组患者的手术时间、切口长度、术中失血量、术后引流量及下地时间比较,差异均无统计学意义(P>0.05),RP组术后6 d发生脱位1例,处理后未再发生脱位,随访未发现其他严重并发症;两组末次随访KSS评分、膝评分及功能评分、疼痛评分、髌骨评分均较术前显著升高(P<0.05),末次随访组间同期比较差异无统计学意义(P>0.05);术后正侧位X线片显示两组术后假体位置均良好,无松动,末次随访膝关节活动度较术前显著增大,胫骨角较术前显著减小(P<0.05),末次随访组间膝关节活动度、胫骨角同期比较差异无统计学意义(P均>0.05)。[结论]RP与FB应用于TKA术治疗终末期膝骨关节炎均可显著改善膝骨关节功能,术后膝关节疼痛明显改善或消失,膝内外翻等畸形得到改善,疗效显著,安全性高。
[Objective] To compare the clinical outcomes of fixed bearing(FB) prosthesis versus rotating platform(RP) prosthesis applied in total knee arthroplasty(TKA) for end-stage knee osteoarthritis. [Methods] A total of 86 patients with endstage knee osteoarthritis received total knee arthroplasty in our hospital from June 2014 to June 2015. Based on subjective willingness of choosing prosthesis, 40 patients had fixed bearing(FB) prosthesis used, while the remaining 46 patients had rotating platform(RP) prosthesis implanted. The perioperative data, including operation time, length of incision, intraoperative blood loss, postoperative drainage, bed rest time and postoperative complications were recorded; additionally, the KSS scores, pain scores and patellar scores, as well as radiographic parameters were used for evaluation of outcomes. [Results] There was no significant difference in operation time, incision length, intraoperative blood loss, postoperative drainage and bed rest time between the two groups(P>0.05). One patient in RP group suffered from dislocation at 6 days after operation and no recurrence of dislocation occurred after close reduction. No other serious complications were found in anyone of them during the follow-up. The KSS score, pain score and patellar score at the last follow-up in both groups were significantly higher than those before surgery(P<0.05), despite no significant difference in any corresponding time points between the two groups(P>0.005). The postoperative anteroposterior and lateral X-ray films showed the prosthesis position was in good position with loosening in both groups.Compared with that before operation, the knee joint mobility at the last follow-up significantly increased, but tibial angle significantly decreased(P<0.05). However, there were no significant differences in knee mobility and tibial angle at any corresponding time points between the two groups(P>0.05). [Conclusion] Both the FB and RP prosthesis TKA do significantly relieve pain, correct knee deformities and improve the function for end-stage knee osteoarthritis.
[Objective] To compare the clinical outcomes of fixed bearing(FB) prosthesis versus rotating platform(RP) prosthesis applied in total knee arthroplasty(TKA) for end-stage knee osteoarthritis. [Methods] A total of 86 patients with endstage knee osteoarthritis received total knee arthroplasty in our hospital from June 2014 to June 2015. Based on subjective willingness of choosing prosthesis, 40 patients had fixed bearing(FB) prosthesis used, while the remaining 46 patients had rotating platform(RP) prosthesis implanted. The perioperative data, including operation time, length of incision, intraoperative blood loss, postoperative drainage, bed rest time and postoperative complications were recorded; additionally, the KSS scores, pain scores and patellar scores, as well as radiographic parameters were used for evaluation of outcomes. [Results] There was no significant difference in operation time, incision length, intraoperative blood loss, postoperative drainage and bed rest time between the two groups(P>0.05). One patient in RP group suffered from dislocation at 6 days after operation and no recurrence of dislocation occurred after close reduction. No other serious complications were found in anyone of them during the follow-up. The KSS score, pain score and patellar score at the last follow-up in both groups were significantly higher than those before surgery(P<0.05), despite no significant difference in any corresponding time points between the two groups(P>0.005). The postoperative anteroposterior and lateral X-ray films showed the prosthesis position was in good position with loosening in both groups.Compared with that before operation, the knee joint mobility at the last follow-up significantly increased, but tibial angle significantly decreased(P<0.05). However, there were no significant differences in knee mobility and tibial angle at any corresponding time points between the two groups(P>0.05). [Conclusion] Both the FB and RP prosthesis TKA do significantly relieve pain, correct knee deformities and improve the function for end-stage knee osteoarthritis.
引文
[1]Hernigou P,Huys M,Pariat J,et al.Comparison of fixed-bearing and mobile-bearing total knee arthroplasty after high tibial osteotomy[J].Int Orthop,2018,42(2):317-322.
[2]汤发强,流小舟,胡世平,等.固定平台与旋转平台全膝关节置换术的疗效对比[J].中国矫形外科杂志,2014,22(22):2053-2058.
[3]Matsumoto K,Iwamoto K,Mori N,et al.In vivo kinematics of a low contact stress rotating platform total knee arthroplasty system under weight bearing and non-weight bearing condition[J].J Orthop Sci,2014,19(5):750-755.
[4]吴广鹏,徐耀增,朱永生,等.高屈曲旋转平台型假体全膝关节置换的近期随访:膝关节活动度及功能评价[J].中国组织工程研究,2015,19(13):2011-2016.
[5]储林洋,尚希福,贺瑞,等.固定平台与旋转平台假体置换治疗膝外翻畸形疗效的比较研究[J].中华骨科杂志,2015,35(8):795-800.
[6]Jain S,Pathak AC,Kalaivanan K.Minimum 5-year follow-up results and functional outcome of rotating-platform high-flexion total knee arthroplasty:a prospective study of 701 knees[J].Arthroplasty Today,2016,2(3):127-132.
[7]Papagiannis GI,Roumpelakis IM,Triantafyllou AI,et al.No differences identified in transverse plane biomechanics between medial pivotand rotating platform total knee implant designs[J].J Arthroplasty,2016,31(8):1814-1820.
[8]陈永志.解剖型旋转平台膝关节假体术后中远期随访观察[J].中国矫形外科杂志,2016,24(17):1617-1620.
[9]Okamoto Y,Nakajima M,Jotoku T,et al.Capsular release around the intercondylar notch increases the extension gap in posteriorstabilized rotating-platform total knee arthroplasty[J].Knee,2016,23(4):730-735.
[10]程金生,李俊霞,周永刚,等.旋转平台与后稳定固定平台假体在人工膝关节置换术后的临床疗效[J].现代生物医学进展,2016,16(4):748-750.
[11]Choi NY,In Y,Bae JH,et al.Are midterm patient-reported outcome measures between rotating-platform mobile-bearing prosthesis and medial-pivot prosthesis different?A minimum of 5-year follow-up study[J].J Arthroplasty,2016,32(3):824-829.
[12]陆思伟,王洋,杨显春,等.全膝关节置换术中旋转平台型与固定平台型假体治疗膝关节病的疗效比较[J].临床骨科杂志,2017,20(4):428-431.
[13]Martin JR,Beahrs TR,Fehring KA,et al.Rotating platform versus fixed bearing total knee arthroplasty at mid-term follow-up[J].Knee,2016,23(6):1055-1058.
[14]Mayr HO,Reinhold M,Hube R,et al.Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform[J].Int Orthop,2014,38(7):1379.
[15]Ko Y,Jang EC,Park SM,et al.No difference in clinical and radiologic outcomes after total knee arthroplasty with a new ultra-congruent mobile bearing system and rotating platform mobile bearing systems after minimum 5-year follow-up[J].J Arthroplasty,2015,30(3):379-383.
[16]Kim YH,Yoon SH,Kim JS.Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobilebearing prosthesis[J].Clin Orthop,2009,467(2):493-503.
[17]Breugem SJ,Sierevelt IN,Schafroth MU,et al.Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis[J].Clin Orthop,2008,466(8):1959-1965.
[18]刘阳,曹力,李纲,等.固定平台型与活动平台型膝关节假体人工全膝关节置换术后膝前痛的比较研究[J].中国修复重建外科杂志,2011,25(3):266-271.
[2]汤发强,流小舟,胡世平,等.固定平台与旋转平台全膝关节置换术的疗效对比[J].中国矫形外科杂志,2014,22(22):2053-2058.
[3]Matsumoto K,Iwamoto K,Mori N,et al.In vivo kinematics of a low contact stress rotating platform total knee arthroplasty system under weight bearing and non-weight bearing condition[J].J Orthop Sci,2014,19(5):750-755.
[4]吴广鹏,徐耀增,朱永生,等.高屈曲旋转平台型假体全膝关节置换的近期随访:膝关节活动度及功能评价[J].中国组织工程研究,2015,19(13):2011-2016.
[5]储林洋,尚希福,贺瑞,等.固定平台与旋转平台假体置换治疗膝外翻畸形疗效的比较研究[J].中华骨科杂志,2015,35(8):795-800.
[6]Jain S,Pathak AC,Kalaivanan K.Minimum 5-year follow-up results and functional outcome of rotating-platform high-flexion total knee arthroplasty:a prospective study of 701 knees[J].Arthroplasty Today,2016,2(3):127-132.
[7]Papagiannis GI,Roumpelakis IM,Triantafyllou AI,et al.No differences identified in transverse plane biomechanics between medial pivotand rotating platform total knee implant designs[J].J Arthroplasty,2016,31(8):1814-1820.
[8]陈永志.解剖型旋转平台膝关节假体术后中远期随访观察[J].中国矫形外科杂志,2016,24(17):1617-1620.
[9]Okamoto Y,Nakajima M,Jotoku T,et al.Capsular release around the intercondylar notch increases the extension gap in posteriorstabilized rotating-platform total knee arthroplasty[J].Knee,2016,23(4):730-735.
[10]程金生,李俊霞,周永刚,等.旋转平台与后稳定固定平台假体在人工膝关节置换术后的临床疗效[J].现代生物医学进展,2016,16(4):748-750.
[11]Choi NY,In Y,Bae JH,et al.Are midterm patient-reported outcome measures between rotating-platform mobile-bearing prosthesis and medial-pivot prosthesis different?A minimum of 5-year follow-up study[J].J Arthroplasty,2016,32(3):824-829.
[12]陆思伟,王洋,杨显春,等.全膝关节置换术中旋转平台型与固定平台型假体治疗膝关节病的疗效比较[J].临床骨科杂志,2017,20(4):428-431.
[13]Martin JR,Beahrs TR,Fehring KA,et al.Rotating platform versus fixed bearing total knee arthroplasty at mid-term follow-up[J].Knee,2016,23(6):1055-1058.
[14]Mayr HO,Reinhold M,Hube R,et al.Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform[J].Int Orthop,2014,38(7):1379.
[15]Ko Y,Jang EC,Park SM,et al.No difference in clinical and radiologic outcomes after total knee arthroplasty with a new ultra-congruent mobile bearing system and rotating platform mobile bearing systems after minimum 5-year follow-up[J].J Arthroplasty,2015,30(3):379-383.
[16]Kim YH,Yoon SH,Kim JS.Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobilebearing prosthesis[J].Clin Orthop,2009,467(2):493-503.
[17]Breugem SJ,Sierevelt IN,Schafroth MU,et al.Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis[J].Clin Orthop,2008,466(8):1959-1965.
[18]刘阳,曹力,李纲,等.固定平台型与活动平台型膝关节假体人工全膝关节置换术后膝前痛的比较研究[J].中国修复重建外科杂志,2011,25(3):266-271.